Implementation of the ACA in Kentucky: Lessons Learned to Date and the Potential Effects of Future Changes

This brief reviews Kentucky’s experiences expanding coverage under the Affordable Care Act (ACA) to highlight lessons learned about what has contributed to the state’s implementation success. It also highlights changes being made to the Marketplace and Medicaid coverage in Kentucky and the potential impact of these changes moving forward. Through case studies and other research, the Kaiser Family Foundation has tracked ACA implementation experiences in Kentucky and several other states through the end of the second open enrollment period in January 2015 (Appendix). Going forward, state experiences through the third open enrollment period and into early 2016 will be examined. Key findings based on the work conducted to date include the following:

Kentucky has had one of the most successful ACA implementation experiences among states. Beginning in 2014, the state expanded Medicaid to low-income adults and built its own State-Based Marketplace, kynect. Since implementing the ACA, Kentucky’s uninsured rate fell from 16% in 2013 to 8% in 2014, one of the largest reductions in the country.1 A number of components contributed to Kentucky’s enrollment success. One of the most pivotal components was the single, integrated eligibility system it built for kynect and Medicaid. Other elements included strong leadership and collaboration, broad outreach and marketing efforts, and a robust and diverse network of enrollment assistance.

Following the expansion, Medicaid enrollees generally have been able to access needed services, with some challenges for specific services and in certain areas. Access for enrollees in Marketplace coverage varies by choice of plan. Per enrollee costs of care for Medicaid expansion adults have been lower than anticipated, and the state has reported cost savings as a result of the expansion.

Kentucky’s newly elected Governor has begun transitioning the fully state-run Marketplace, kynect, to a federally-supported State-Based Marketplace. With this transition, the state will rely on Healthcare.gov for some functions, including Marketplace eligibility determinations and enrollment.2 In addition, the Governor plans to seek a waiver to make changes to the Medicaid expansion.3 Looking ahead it will be important to assess how these changes may reshape coverage in Kentucky, including how the Marketplace transition affects Medicaid and Marketplace outreach and enrollment, insurer participation and plan offerings, and, if implemented, the impact of the Medicaid waiver.